Application number or IRN (for FCA/PRA use only) Solvency II Firms 1 : Scope of Responsibilities For candidates for approval, this form must be submitted as an attachment to a Form A application or a Form E application PRA Rulebook Reference: Solvency II firms: Senior Insurance Managers Regime Applications and Notifications Please note: this form does NOT need to be completed for candidates for controlled function CF30 only. Name of individual (to be completed by firm) Name of firm (as entered in 2.01) Financial Conduct Authority 25 The North Colonnade Canary Wharf London E14 5HS United Kingdom Telephone +44 (0) 300 500 0597 E-mail iva@fca.org.uk Website http://www.fca.org.uk Prudential Regulation Authority 20 Moorgate London EC2R 6DA United Kingdom Telephone +44 (0) 203 461 7000 Email PRA-ApprovedPersons@bankofengland.co.uk Website www.bankofengland.co.uk/pra 1 Please see the FCA Handbook Glossary for the definition of Solvency II firm, and for the PRA see the firms included in PRA Rulebook: Solvency II firms: Insurance- Senior Insurance Management Functions Chapter 1 (Applications and Definitions)
Personal identifications details Section 1 1.01 Individual Reference Number (IRN) 1.02 Title (e.g. Mr, Mrs, Ms, etc) 1.03 Surname 1.04 ALL forenames 1.05 Date of birth 1.06 National Insurance number Firm identification details Section 2 2.01 Name of firm 2.02 Firm Reference Number (FRN) 2.03 a Who should the FCA/PRA contact at the firm in relation to this scope of responsibilities? b Position c Telephone d Fax e E-mail I have supplied further information related to this page in Section 4 YES NO
Controlled Functions Section 3 A Scope of Responsibilities should be drafted to clearly show the responsibilities that the candidate is to perform as part of their controlled function and other relevant responsibilities and how they fit in with the firm s overall governance and management arrangements. A Scope of Responsibilities should be drafted in such a way as to be practical and useable by regulators. The FCA and the PRA consider that this would be achieved by succinct, clear descriptions of each responsibility which avoid unnecessary detail. Firms have the opportunity to provide details of each responsibility allocated to an individual using the free text boxes in this form, however, the PRA and FCA would not usually expect the description of each responsibility to exceed 300 words. A Scope of Responsibilities must be a self-contained document. There should be one document per Senior Insurance Management Function (SIMF) holder or Significant Influence Function (SIF) holder per firm. Where an individual performs a senior insurance manager or significant influence function on behalf of more than one firm within a group, one Scope of Responsibilities is required for each firm. Any supplementary information may be provided in section 4 (or if submitting electronically, in a single attachment). A Scope of Responsibilities must not cross refer to or include other documents, attachments or links. If the appropriate regulator considers that the Scope of Responsibilities is not sufficiently clear to be practical and usable, it could be challenged as part of a candidate s application for approval, or in ongoing supervision. Details of the individual s responsibilities should be set out in sections 3.2 and 3.3, as appropriate: Section 3.2 covers those responsibilities required by regulators to be allocated to one or more controlled functions. Section 3.3 covers anything else, not otherwise included, for which an individual is to be responsible. 3.1 Effective date and relevant Controlled Functions 3.1.1 Please state the effective date of this Scope of Responsibilities: 3.1.2 List all SIMFs and SIFs which the individual is to perform and the effective date the person commenced or will commence the performance of the functions. Please include those FCA functions that are included in a PRA controlled function under PRA Rulebook: Solvency II firms: Insurance - Senior Insurance Management Functions Chapter 2. Function Description of a controlled function Tick (if ) Effective Date SIMF 1 SIMF 2 SIMF 4 SIMF 5 SIMF 7 SIMF 9 SIMF 10 SIMF 11 SIMF 12 SIMF 14 Chief Executive officer* Chief Finance function* Chief Risk officer* Head of Internal Audit* Group Entity Senior Manager Chairman* Chair of the Risk Committee* Chair of the Audit Committee* Chair of the Remuneration Committee* Senior Independent Director*
Function Description of a controlled function Tick (if ) Effective Date SIMF 19 SIMF 20 SIMF21 SIMF22 SIMF23 SIMF26 CF 1 CF 2a CF 2b CF 5 CF 10 CF 10a CF 11 CF 28 CF 29 CF 51 Head of Third Country Branch function Chief Actuary* With Profits Actuary* Underwriting function Underwriting Risk Oversight Officer (Lloyd s) Head of a small run-off firm function Director Chair of the Nominations Committee* Chair of the With-Profits Committee Director of unincorporated association function Compliance Oversight* CASS Operational Oversight Money Laundering Reporting* Systems and Controls Significant Management Actuarial conduct function (third country) Please note that for those roles asterisked above, this scope of responsibilities is considered to automatically include the existing legal and regulatory obligations for these roles. For example, certain specific responsibilities of a director are set out in company law. Such responsibilities do not need to be recorded in this statement, but any additional responsibilities should be recorded in the sections below.
3.2 PRA Prescribed Responsibilities This section deals with those responsibilities required by PRA rules to be allocated to one or more controlled functions. If the responsibilities that the candidate or a person performing SIMFs or SIFs is to carry out as described in the scope of responsibilities go beyond those set out in this section, those additional responsibilities should not reduce or alter the scope of the prescribed requirements set out in this section. 3.2.1 Please indicate below which of the responsibilities listed are/will be allocated to this individual. Where responsibilities are shared (for example, a responsibility may be shared as part of a job share or where departing and incoming controlled functions work together temporarily as part of a handover), please provide details. If the individual has not been allocated a prescribed responsibility in this list, please go to section 3.3. Ref Prescribed Responsibilities Tick if 1 Ensuring that the firm has complied with the obligation to ensure that every person who performs a key function is fit and proper 2 Leading the development of the firm s culture by the governing body as a whole 3 Overseeing the adoption of the firm s culture in its day-to-day management 4 Production and integrity of the firm s financial information and regulatory reporting 5 Management of the allocation and maintenance of the firm s capital and liquidity 6 Development and maintenance of the firm s business model by the governing body 7 Performance of the firm s Own Risk and Solvency Assessment (ORSA) 8 Policies and procedures for the induction, training and professional development for all members of the firm s governing body 9 Policies and procedures for the induction, training and professional development for all the firm s key function holders (other than members of the firm s governing body) 10 Oversight of the independence, autonomy and effectiveness of the whistleblowing policies and procedures, including those for the protection of staff raising concerns
Ref Prescribed Responsibilities Tick if 11 Oversight of the firm s remuneration policies and practices I have supplied further information related to this page in Section 4 YES NO 3.2.2 If necessary, please provide additional information about each prescribed responsibility, including: a breakdown of the different components and tasks which the responsibility encompasses; and if, details of any sharing arrangements including, if known, the name(s), IRN(s) and/or job title(s) of the individual(s) you are sharing this prescribed responsibility with. The responsibility should be recorded in the same way in the scope of responsibilities documents for each individual. Additional information must be relevant, succinct and not dilute or undermine the prescribed responsibility.
Ref Prescribed Responsibility Further Relevant Details 15.7.9G of the FCA Handbook and/or Senior Insurance Managers Regime Applications and Notifications of the PRA Rulebook as
3.3 Other Responsibilities 3.3.1 Please set out below anything else, not otherwise included in this statement, for which a candidate or SIMF or SIF is to be responsible as part of their FCA and/or PRA controlled function(s) or key function(s) role. For a firm that is not significant, which outsources its internal audit function to an external third party service provider (that is, a service provider outside the firm or the firm's group), this should include the allocation, where, of the responsibility for the provision of an effective internal audit function, and oversight of the performance of that function [see Insurance Allocation of Responsibilities 3.3] For a small run-off firm, this should include the allocation, where, of each of the following responsibilities that are set out in Insurance Allocation of Responsibilities 3.2 Providing governing body with business plan and management information Management of financial resources Ensuring governing body is kept informed of legal & regulatory obligations Oversight of systems & controls, and risk management policies and procedures Responsibility Yes/ No Is this responsibility shared with another SIMF or SIF If yes please provide further details in section 4: Is this responsibility divided with another SIMF or SIF i.e. are you responsible for part of this responsibility rather than all of it? If yes please provide further details in section 4: Please provide a description of your responsibilities: I have supplied further information related to this page in Section 4 YES NO
Supplementary Information Section 4 4.1 Is there any other information the individual or the firm considers to be relevant? YES NO If yes, please provide details below or on a separate sheet of paper and clearly identify the section and question to which the additional information relates. Question Information 4.2 How many additional sheets are being submitted?
Declarations and signatures Section 5 Declaration of Candidate It is a criminal offence, knowingly or recklessly, to give the FCA and/or PRA information that is materially false, misleading or deceptive (see sections 398 and 400 Financial Services and Markets Act 2000). Even if you believe or know that information has been provided to the FCA and/or PRA before (whether as part of another application or otherwise) or is in the public domain, you must nonetheless disclose it clearly and fully in this form and as part of this application you should not assume that the FCA and/or PRA will itself identify such information during the assessment of this application. If there is any doubt about the relevance of information, it should be included. There will be a delay in processing the application if information is inaccurate or incomplete, and it may call into question the suitability of the candidate and/or lead to the FCA and/or PRA exercising its powers (including but not limited to taking disciplinary/ Enforcement action). You must notify the FCA and/or PRA immediately if there is a change to the information in this form and/or if inaccurate information has been provided (insofar as the FCA and/or PRA are reasonably likely to consider the information material). The candidate confirms that the information provided in this application is accurate and complete to the best of his/her knowledge and that he or she has read the notes to this form. The candidate will notify the FCA and/or PRA immediately if there is a material change to the information provided. The candidate confirms that the attached Scope of Responsibilities 2 accurately reflects the aspects of the affairs of the firm which it is intended that the candidate will be responsible for managing. The candidate confirms that they have accepted all the responsibilities set out in this Scope of Responsibilities. The candidate authorises the FCA and/or PRA to make such enquiries and seek such further information as it thinks appropriate to identify and verify information that it considers relevant to the assessment of this application. The candidate acknowledges and agrees that these checks may include credit reference checks or information pertaining to fitness and propriety, and is aware that the results of these enquiries may be disclosed to the employer/applicant. The candidate agrees that he or she may be required to apply for a search to be made as to whether any criminal records are held in relation to him or her and to obtain a certificate (where such certificate can be obtained) and to disclose the result of that search to the firm submitting this application. The candidate agrees that the FCA and/or PRA may use the address specified for the candidate in this form as the proper address for service in the United Kingdom as defined in Financial Services and Markets Act 2000 (Service of Notice) Regulations (SI 2001/1420) to serve any notices on that signatory. For the purposes of complying with the Data Protection Act 1998, the personal information provided in this Form will be used by the FCA and PRA to discharge their statutory functions under the Financial Services and Markets Act 2000 and other relevant legislation, and will not be disclosed for any other purpose without the permission of the applicant. The candidate confirms that he or she understands the regulatory responsibilities of the proposed role as set out in the rules of conduct in the FCA s COCON and/or PRA Rulebook: Solvency II firms: Insurance- Conduct Standards (as ). The candidate is aware that, while advice may be sought from a third party (e.g. legal advice), responsibility for the accuracy of information, as well as the disclosure of relevant information, on the Form is ultimately the responsibility of those who sign the application. In addition to other regulatory responsibilities, firms, and approved persons have a responsibility to disclose to the FCA and/or PRA matters of which it would reasonably expect to be notified. Failure to notify the FCA and/or PRA of such information may lead to the FCA and/or PRA taking disciplinary or other action against the Applicant and/or the candidate. Tick here to confirm you have read and understood this declaration: 5.01 Candidate's full name 5.02 Signature * Date 2 This is not for candidates for controlled function CF30 only. * The above question(s) appears on a paper form submission only. That question does not appear on an electronic form submission.
Declaration by Individual* The individual confirms that this Scope of Responsibilities form accurately reflects the aspects of the affairs of the firm which it is intended that the individual will be responsible for managing. The individual confirms that they have accepted all the responsibilities set out in this Scope of Responsibilities. Tick here to confirm you have read and understood this declaration: 5.01 Individual's full name 5.02 Signature* Date Declaration by Firm* The Firm confirms that this Scope of Responsibilities form accurately reflects the aspects of the affairs of the Firm which it is intended that the individual will be responsible for managing. In signing this form on behalf of the firm: I confirm that the information in this Form is accurate and complete to the best of my knowledge and belief and that I have read the notes to this Form. I confirm that I have authority to make this application and provide the declarations given by the firm, and sign this Form, on behalf of the firm identified in section 2.01. 5.03 Name of the firm submitting the scope of responsibilities 5.04 Name of person signing on behalf of the firm 5.05 Job title 5.06 Signature* Date